Metabolic studies in multiple injured patients. Clinical features, routine chemical analyses and nitrogen balance.

The effect of three different isocaloric parenteral nutritional regimes has been investigated in the early postoperative period in 19 patients with severe multiple injuries. Clinical course, biochemical analyses and nitrogen balance were monitored. The first group received glucose and insulin (n = 7), the second group fat and glucose (n = 6) and the third group fat, glucose and 24 g aminoacid-nitrogen (n = 6). The clinical course was similar in the three groups and all patients survived. The biochemical changes showed a typical pattern for trauma and there were no differences between the groups except for urea, which was significantly higher in the group receiving amino acids. The cumulative nitrogen balance was markedly less negative one week after trauma (-45 g N +/- 8) in the group given amino acids, glucose and fat compared to those given isocaloric amounts of glucose (-84 g N +/- 12) or glucose and fat (-95 g N +/- 10). This improvement in nitrogen balance was probably mainly due to an increase in protein synthesis.